Abstract
ObjectivesThis retrospective study compared two mandibular reconstruction procedures—conventional reconstruction plates (CR) and patient-specific implants (PSI)—and evaluated their accuracy of reconstruction and clinical outcome.MethodsOverall, 94 patients had undergone mandibular reconstruction with CR (n = 48) and PSI (n = 46). Six detectable and replicable anatomical reference points, identified via computer tomography, were used for defining the mandibular dimensions. The accuracy of reconstruction was assessed using pre- and postoperative differences.ResultsIn the CR group, the largest difference was at the lateral point of the condyle mandibulae (D2) -1.56 mm (SD = 3.8). In the PSI group, the largest difference between preoperative and postoperative measurement was shown at the processus coronoid (D5) with +1.86 mm (SD = 6.0). Significant differences within the groups in pre- and postoperative measurements were identified at the gonion (D6) [t(56) = -2.217; p = .031 <.05]. In the CR group, the difference was 1.5 (SD = 3.9) and in the PSI group -1.04 (SD = 4.9). CR did not demonstrate a higher risk of plate fractures and post-operative complications compared to PSI.ConclusionFor reconstructing mandibular defects, CR and PSI are eligible. In each case, the advantages and disadvantages of these approaches must be assessed. The functional and esthetic outcome of mandibular reconstruction significantly improves with the experience of the surgeon in conducting microvascular grafts and familiarity with computer-assisted surgery. Interoperator variability can be reduced, and training of younger surgeons involved in planning can be reaching better outcomes in the future.
Highlights
After continuity resections of the lower jaw in case of carcinoma, osteonecrosis, osteomyelitis, or trauma, a mandibular reconstruction is essential to restore function and esthetics [1, 2]
The patient collective was distributed in two groups and analyzed according to age at the time of surgery, gender, clinical picture, and resection size
We investigated how the success of the operation is influenced by pre-existing diseases, previous operations, the size and etiology of the defect, localization, and occurring complications
Summary
After continuity resections of the lower jaw in case of carcinoma, osteonecrosis, osteomyelitis, or trauma, a mandibular reconstruction is essential to restore function and esthetics [1, 2]. Defects of the mandible are reconstructable using either a reconstruction plate without bony reconstruction or immediately with a combination of reconstruction plate and primary bone flap. Advancements in computer-assisted surgery (CAS), with regard to computer-aided design/computer-aided manufacturing (CAD/CAM) technology, are beneficial compared to the traditional method of mandibular reconstruction with handbent plates [5,6,7,8,9,10,11,12,13,14,15]. The accuracy of CAD/CAM or selective laser melting plates is superior to the manually bent reconstruction plates. These plates provide greater results in terms of strength and intraoperative positioning [16]. The decisive factors for this procedure are anatomical and symmetrical bone shaping, restoration of a stable dental occlusion, and condylar repositioning into a centric relation [5, 17,18,19]
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